Fibroids. Myometrial tumor. Most common of all tumors in females!! Often multiple tumors, well demarcated, increase in blacks, benign SM tumor, rarely malignantEstrogen sensitive so increase size in pregnancy and dec. size with menopausePeaks in 20-40yo range. Asymptomatic or if symptoms, multipleSevere bleeding may lead to iron deficiencyDoes NOT progress to leiomyosarcomaWhorled pattern of SM bundles.

Subsequent fetus taht is Rh+ to an Rh- mother already giving birth to a fetus that was Rh+.Mother makes Ab against Rh during first pregnancy and they cross placenta during next causing hemolytic disease of newbornTreat: rhogam (Rh Ag Ig at first delivery)

(LEAD: Lead lines on gingivae = burton's lines...and on epiphyses of long bones. Encephalopathy and Erythrocyte basophilic stippling, Abdominal colic and sideroblastic anemia, Drops wrist and foot, Dimercaprol and EDTA are treatments or Succimer for kids)

Extrinsic Hemolytic Normocytic Anemia. Pathogenesis: RBCs are damaged when passing through obstructed or narrowed vessel lumina. Seen in DIC, TTP-HUS, SLE, and malignant hypertension.Schistocytes (helmet cells) are seen on blood smear due to mechanical destruction of RBCs

HIT: heparin binds to platelets, causingautoantibody production that binds to and activates platelets leading to their clearance and resulting in a thrombocytopenic hypercoagulable state

LMWH

Newer low-molecular-weight heparins (e.g., enoxaparin) act more on Xa. have better bioavailability and 2-4 times longer half-life, can be administered subcutan. and without laboratory monitoring. Not easily reversible.

Lepirudin, bivalirudin

Hirudin derivatives, Direct thrombin inhibitorsuse as alternative to heparin for patients with HIT

Warfarin (coumadin)

Interferes with normal syn and gamma-carboxylation of vitamin K-dependent clotting (factors 2,7,9,10,C,S).Metabolized by the cytochrome P-450 palhway. In laboratory assay, haseffect on EXtrinsic pathway and inc PT. Long half-life.

Used for: Chronic anticoagulation. Not used in pregnant women (because warfarin, unlike heparin, can cross the placenta). Follow PT/INR values.